本文選題：靜脈回流障礙 + 頸靜脈狹窄/閉塞��； 參考：《吉林大學(xué)》2015年博士論文

【摘要】：腦靜脈系統(tǒng)一直被認(rèn)為僅僅是收集血液回心臟的通路然而近年的研究發(fā)現(xiàn)腦靜脈系統(tǒng)在腦血流調(diào)節(jié)中起著重要的作用，腦靜脈回流障礙可以引起嚴(yán)重顱內(nèi)壓增高，腦灌注壓下降，腦功能障礙而且某些神經(jīng)系統(tǒng)疾病與腦靜脈系統(tǒng)異常相關(guān)，如短暫性全面遺忘癥ǐ短暫性單眼失明ǐ恐慌癥等 既往研究報道，頸靜脈瓣膜關(guān)閉不全導(dǎo)致的頸靜脈返流是腦靜脈回流障礙的發(fā)病機(jī)制，頸靜脈瓣膜的功能是防止頸靜脈逆流及胸內(nèi)壓力上傳顱內(nèi)，當(dāng)頸靜脈瓣膜關(guān)閉不全時，，Valsalva動作（valsalva maneuver, VM）誘發(fā)的胸內(nèi)壓力增高將上傳顱內(nèi)導(dǎo)致頸靜脈返流，但一系列研究并未發(fā)現(xiàn)任何與頸靜脈瓣膜關(guān)閉不全存在對應(yīng)關(guān)系的顱內(nèi)靜脈回流模式的形態(tài)學(xué)改變，人們開始探索是否有其他因素可導(dǎo)致腦靜脈回流障礙 頸內(nèi)靜脈（internal jugular vein，IJV）是腦靜脈回流心臟的主要回流通路，頭ǐ頸靜脈先天發(fā)育不良或者狹窄/閉塞是否會導(dǎo)致頸內(nèi)靜脈形態(tài)和血流動力學(xué)改變尚不清楚我們提出假設(shè)，除了頸靜脈瓣膜關(guān)閉不全，是否頭ǐ頸靜脈先天發(fā)育不良或者狹窄/閉塞也會導(dǎo)致頸內(nèi)靜脈回流障礙，并影響腦靜脈回流及腦循環(huán)，出現(xiàn)腦功能障礙正是帶著這個問題，我們利用核磁共振成像技術(shù)（magnetic resonance imaging, MR imaging）及頸部靜脈超聲技術(shù)，進(jìn)行了關(guān)于頭頸靜脈回流障礙發(fā)病機(jī)制的初步研究旨在闡明頭ǐ頸靜脈狹窄/閉塞或者先天發(fā)育不良對頸內(nèi)靜脈回流障礙及腦靜脈系統(tǒng)及腦循環(huán)的影響，為頭頸靜脈回流障礙導(dǎo)致顱內(nèi)靜脈充血/高壓的發(fā)病機(jī)制提供證據(jù)本研究共分四個部分： 第一部分：頭頸靜脈回流障礙是短暫性全面遺忘癥發(fā)病機(jī)制的新證據(jù) 既往研究報道，Valsalva動作誘發(fā)的因頸靜脈瓣膜關(guān)閉不全導(dǎo)致的頸靜脈返流是短暫性全面遺忘癥（transient global amnesia, TGA）的發(fā)病機(jī)制然而研究發(fā)現(xiàn)VM期間短暫增高的胸腹壓力主要是通過椎靜脈系統(tǒng)上傳顱內(nèi)及通過頸內(nèi)靜脈下傳，所以通暢的頸內(nèi)靜脈對顱內(nèi)釋放短暫增高的壓力及腦靜脈的回流非常重要，單純的頸靜脈瓣膜關(guān)閉不全并不會引發(fā)頸靜脈回流障礙導(dǎo)致的短暫性全面遺忘癥因此我們假設(shè)頸靜脈受壓所致的頸內(nèi)靜脈回流障礙是TGA發(fā)病機(jī)制中的決定性因素方法：本研究是病例對照研究，利用MR，包括應(yīng)用造影劑的增強(qiáng)軸向T1加權(quán)核磁共振成像（contrast-enhanced axialT1-weighted MR imaging, Contrast T1）與時間分辨對比劑動態(tài)成像（time-resolved imagingof contrast kinetics, TRICKS），及未應(yīng)用造影劑的核磁共振靜脈血管成像（magneticresonance venography, MRV），評估雙側(cè)頸內(nèi)靜脈與左側(cè)頭臂靜脈（brachiocephalic vein,BCV）的形態(tài)學(xué)，及橫竇（transverse sinus, TS）的不對稱性，其中頸內(nèi)靜脈被分成上ǐ中及下段結(jié)果：與對照組比較，TGA者雙側(cè)頸內(nèi)靜脈上段（left:37.8%vs.17.8%,P=0.0393; right:57.8%vs.15.6%, P0.0012）及左側(cè)頭臂靜脈（60%vs.8.9%, P0.0004）中ǐ重度狹窄/閉塞，及橫竇發(fā)育不良（53.3%%vs.31.1%, P=0.0405）的比例顯著高靜脈回流的任何部位狹窄/閉塞（包括頸內(nèi)靜脈任意部位或者左側(cè)頭臂靜脈狹窄/閉塞）的比例在病例組顯著高于對照組（91.1%vs.33.3%, P0.0004） MRV發(fā)現(xiàn)左側(cè)橫竇的管徑在病例組較對照組顯著�。�0.31±0.21vs.0.41±0.19, P=0.0290），而Contrast T1發(fā)現(xiàn)左側(cè)橫竇的管徑在病例組與對照組無差異，這個結(jié)果符合回流靜脈近心端狹窄/閉塞結(jié)論：頭頸靜脈回流障礙是引起TGA的主要原因之一；雙側(cè)頸內(nèi)靜脈和/或者左側(cè)頭臂靜脈狹窄/閉塞及橫竇發(fā)育不良是導(dǎo)致頭頸靜脈回流障礙的重要因素 第二部分：橫竇發(fā)育不良導(dǎo)致頭頸靜脈回流障礙的新證據(jù) 以往認(rèn)為左側(cè)橫竇發(fā)育不良多為生理性變異，無明顯臨床意義最近研究發(fā)現(xiàn)橫竇發(fā)育不良與一些神經(jīng)系統(tǒng)疾病密切相關(guān)本研究應(yīng)用MR和頸部靜脈超聲探索了橫竇發(fā)育不良與TGAǐTMBǐ恐慌癥的相關(guān)性，及超聲診斷橫竇發(fā)育不良的臨床應(yīng)用價值方法：本研究回顧性分析了三個病例對照研究的數(shù)據(jù)，包括TGA，短暫性單眼失明（transient monocular blindness，TMB）及恐慌癥（panic disorders），同時行MR檢查及頸部靜脈超聲檢查共131例MR測量橫竇的管徑，及明確頸靜脈狹窄/閉塞的部位和程度頸部靜脈超聲測量頸內(nèi)靜脈（中段J2及上段J3）的截面積（cross-sectional lumen area,CSA, cm2）ǐ血流速度（time-average-mean velocity, TAMV, cm/s）及血流量（flow volume,FV, ml/min）結(jié)果：MRV顯示發(fā)育不良的橫竇69例中，30例被Contrast T1證實(shí)其管徑�。ū欢x為解剖型橫竇發(fā)育不良），39例被Contrast T1證實(shí)其管徑不�。ū欢x為低血流型橫竇發(fā)育不良），后者至少存在頸內(nèi)靜脈任意一個部位和/或者左側(cè)頭臂靜脈狹窄/閉塞（P=0.0002） Contrast T1顯示發(fā)育不良對側(cè)的橫竇管徑無代償性增大頸部靜脈超聲研究顯示，橫竇發(fā)育不良側(cè)上段頸內(nèi)靜脈（J3）截面積顯著�。≒0.0001）對側(cè)/同側(cè)上段頸內(nèi)靜脈（J3）截面積的比值1.55作為診斷橫竇發(fā)育不良的截斷點(diǎn)，其敏感性0.80，特異性0.81，陽性預(yù)測值0.82結(jié)論：橫竇發(fā)育不良可分為解剖型及低血流型兩種類型頸內(nèi)靜脈流量低，管徑小與橫竇發(fā)育不良導(dǎo)致的頸靜脈回流障礙密切相關(guān)，其中低血流型與頸靜脈狹窄/閉塞導(dǎo)致的頸靜脈回流障礙相關(guān)，解剖型與橫竇本身發(fā)育不良導(dǎo)致的頸靜脈回流障礙相關(guān)頸靜脈回流障礙是TGAǐTMBǐ恐慌癥的主要原因之一 第三部分：VM期間頸內(nèi)靜脈無回流可作為頭頸靜脈回流障礙的新證據(jù) 研究已知VM期間短暫增高的胸腹壓力主要是通過椎靜脈系統(tǒng)上傳，通過頸內(nèi)靜脈下傳，所以通暢的頸內(nèi)靜脈對釋放短暫增高的壓力及腦靜脈的回流非常重要研究的第一ǐ二部分，利用MR證實(shí)了TGA者存在頸靜脈狹窄/閉塞或者橫竇先天發(fā)育不良，這支持腦靜脈回流障礙的理論，本部分應(yīng)用超聲進(jìn)一步研究TGA者頸內(nèi)靜脈相應(yīng)的功能或者血流動力學(xué)改變，進(jìn)一步驗證腦靜脈回流障礙的理論我們假設(shè)頭ǐ頸靜脈狹窄/閉塞或者先天發(fā)育不良將導(dǎo)致頸內(nèi)靜脈的血流動力學(xué)改變，進(jìn)一步評估頭頸靜脈狹窄/閉塞或者先天發(fā)育不良與頸靜脈回流障礙之間的相關(guān)性方法：本研究是病例對照研究利用頸部靜脈超聲，觀察TGA組與正常對照組，平靜呼吸狀態(tài)下頸內(nèi)靜脈（包括J2和J3）的血流速度ǐ截面積及血流量，及VM期間頸內(nèi)靜脈是否回流結(jié)果：與對照組比較，平靜呼吸狀態(tài)下，TGA組雙側(cè)上段頸內(nèi)靜脈（J3）及中段（J2）的血流速度及血流量均低，左側(cè)著；且VM期間，TGA組上段（J3）ǐ中段（J2）頸內(nèi)靜脈無回流的比例高，以右側(cè)著VM期間，與無頸靜脈狹窄/閉塞或者橫竇先天發(fā)育不良比較，頸靜脈存在狹窄/閉塞或者先天發(fā)育不良者中，頸內(nèi)靜脈無回流的比例高，以右側(cè)頸內(nèi)靜脈狹窄/閉塞，及橫竇發(fā)育不良者著結(jié)論：頸內(nèi)靜脈低流速低流量且VM期間頸內(nèi)靜脈無回流與頸靜脈狹窄/閉塞或者橫竇先天發(fā)育不良致頸靜脈回流障礙相關(guān)，支持頭頸靜脈回流障礙是TGA發(fā)病主要原因之一的理論；VM期間頸靜脈無回流可作為評估頭頸靜脈回流障礙的檢測手段 第四部分：頭頸靜脈回流障礙的超聲診斷標(biāo)準(zhǔn) 為了更深入研究頭ǐ頸靜脈回流障礙與神經(jīng)疾病的相關(guān)性，以MR的頸靜脈回流障礙的形態(tài)學(xué)作為對照，超聲觀察頸靜脈回流障礙相應(yīng)的血流動力學(xué)改變，初步建立頸靜脈回流障礙的超聲診斷標(biāo)準(zhǔn)方法：回顧性分析110例同時進(jìn)行MR包括Contrast T1ǐTRICKS及MRV，及靜脈超聲檢查包括不同呼吸誘發(fā)試驗，如平靜呼吸狀態(tài)ǐ深吸氣ǐ呼氣及VM排除標(biāo)準(zhǔn)是VM不能持續(xù)15秒鐘，及吹氣壓力不能達(dá)到40mmHg MR評估頸內(nèi)靜脈（internal jugular vein, JIV）與頭臂靜脈（brachiocephalic vein, BCV）狹窄/閉塞及橫竇發(fā)育不良，超聲評估不同呼吸狀態(tài)下IJV及椎靜脈的血流動力學(xué)參數(shù)，如截面積（cross-sectional lumen area, CSA, cm2）ǐ血流速度（time-average-mean velocity, TAMV,cm/s）及血流量（flow volume, FV, ml/min）結(jié)果：比較有或無IJV重度狹窄/閉塞：當(dāng)上段頸內(nèi)靜脈（C1）重度狹窄/閉塞（MR結(jié)果）時，超聲提示同側(cè)中段頸內(nèi)靜脈(J2)的CSA小，尤其在吸氣時，被壓側(cè)顯著變�。划�(dāng)中段頸內(nèi)靜脈（C4）重度狹窄/閉塞（MR結(jié)果）時，超聲提示同側(cè)上段頸內(nèi)靜脈（J3）平靜呼吸狀態(tài)FV低但是因為超聲數(shù)據(jù)的變異性太大，利用統(tǒng)計學(xué)方法ROC曲線（receiver-operating characteristic, ROC)，無法找出C1或者C4狹窄/閉塞時有效的超聲診斷截斷點(diǎn)比較有或無左側(cè)BCV重度狹窄/閉塞：中段頸內(nèi)靜脈（J2）的TAMV及FV均顯著低，但CSA顯著高，提示靜脈下游被壓利用ROC曲線進(jìn)一步評估BCV是否存在狹窄/閉塞的診斷的最佳截斷點(diǎn)，發(fā)現(xiàn)左側(cè)中段頸內(nèi)靜脈（J2）平靜呼吸狀態(tài)的TAMV值8.0(cm/s)時，可以兼顧敏感性與特異性，敏感性0.78，特異性0.61，陽性預(yù)測值0.63結(jié)論：本研究通過MR與頸靜脈超聲對比研究，發(fā)現(xiàn)超聲評估頸內(nèi)靜脈回流障礙與MR評估靜脈的形態(tài)學(xué)存在相應(yīng)關(guān)系MR能夠明確診斷靜脈是否存在狹窄/閉塞ǐ狹窄/閉塞的部位及程度，及橫竇先天發(fā)育不良超聲通過不同呼吸狀態(tài)下頸內(nèi)靜脈的血流速度ǐ血流量及管徑及VM期間頸內(nèi)靜脈是否回流診斷頸靜脈是否存在回流障礙聯(lián)合MR及超聲，不但明確頸靜脈存在回流障礙，而且明確部位及程度 本研究是頭頸靜脈回流障礙與神經(jīng)系統(tǒng)疾病臨床相關(guān)性的研究我們通過MR及頸部靜脈超聲的對比研究，發(fā)現(xiàn)了頭ǐ頸靜脈狹窄/閉塞，及橫竇先天發(fā)育不良導(dǎo)致的頸靜脈回流障礙是TGAǐTMBǐ恐慌癥主要的發(fā)病原因之一；超聲檢查頸內(nèi)靜脈的低流速低流量及VM期間頸內(nèi)靜脈無回流可以作為評估頸靜脈回流障礙的檢測手段；MR及超聲聯(lián)合檢查可以明確頸靜脈回流障礙與橫竇發(fā)育不良ǐ頸靜脈狹窄/閉塞的相關(guān)性
[Abstract]:The cerebral venous system has been thought to be the only way to collect blood back to the heart. However, recent studies have found that the cerebral venous system plays an important role in the regulation of cerebral blood flow. Cerebral venous backflow disorder can cause severe intracranial pressure, cerebral perfusion pressure, cerebral dysfunction and some nervous system diseases and cerebral venous system abnormalities. Such as transient global amnesia, transient monocular blindness, panic disorder, etc.
Previous studies have reported that jugular regurgitation caused by insufficiency of jugular valvular insufficiency is the pathogenesis of cerebral venous reflux disorder. The function of the jugular valve is to prevent the jugular reflux and intrathoracic pressure to upload to the intracranial. When the jugular valve insufficiency is incomplete, the increased intrathoracic pressure induced by the Valsalva action (Valsalva maneuver, VM) will upload the intracranial pressure. But a series of studies did not find any morphological changes in the pattern of intracranial venous reflux associated with the occlusion of the jugular valvular insufficiency, and people began to explore whether there were other factors that could lead to cerebral venous reflux disorder.
The internal jugular vein (internal jugular vein, IJV) is the main recirculation pathway of the cerebral venous reflux. It is not clear whether the congenital hypoplasia of the jugular vein or the stenosis / occlusion will lead to the changes of the internal jugular vein and the hemodynamics. The stenosis / occlusion can also lead to the obstruction of the internal jugular vein, which affects the cerebral venous return and the cerebral circulation. It is the problem that the brain dysfunction is happening. We use the magnetic resonance imaging (MR imaging) and the neck venous ultrasound technique to make a preliminary study on the pathogenesis of the head and neck venous backflow disorder. The aim of this study is to elucidate the effects of cervical venous stenosis / occlusion or congenital dysplasia on the internal jugular venous flow disorder, cerebral venous system and cerebral circulation, and to provide evidence for the pathogenesis of intracranial venous congestion / high pressure caused by the head and neck venous reflux disorder, which are divided into four parts:
Part one: new evidence for the pathogenesis of transient global amnesia.
Previous studies have reported that Valsalva induced jugular regurgitation caused by jugular insufficiency in the jugular vein is the pathogenesis of transient global amnesia (TGA). However, it is found that the transient increased thoracic and abdominal pressure during VM is mainly transmitted through the vertebral vein system and through the internal jugular vein. The unobstructed internal jugular vein is important for the transient pressure of intracranial release and the reflux of the cerebral veins. Simple jugular insufficiency does not lead to transient total amnesia caused by the obstruction of the jugular vein. Therefore, we hypothesized that the internal jugular venous reflux caused by the compression of the jugular vein is the decisive factor in the pathogenesis of TGA. This study was a case-control study, using MR, including enhanced axial T1 weighted magnetic resonance imaging (contrast-enhanced axialT1-weighted MR imaging, Contrast T1) with contrast agent (Contrast T1) and time resolved contrast agent dynamic imaging (time-resolved Imagingof contrast kinetics,), and nuclear magnetic resonance without contrast agent. Magneticresonance venography (MRV) was used to evaluate the morphology of bilateral internal jugular vein and the left head arm vein (brachiocephalic vein, BCV), and the asymmetry of the transverse sinus (transverse sinus, TS). The internal jugular vein was divided into the upper and lower segments of the upper and lower segments. Compared with the control group, the upper part of the bilateral internal jugular vein (left:37.8%v) (left:37.8%v) was compared with the control group S.17.8%, P=0.0393; right:57.8%vs.15.6%, P0.0012) and the severe stenosis / occlusion of the left head arm vein (60%vs.8.9%, P0.0004), and the ratio of 53.3%%vs.31.1%, P=0.0405 to any part of the stenosis / occlusion (including any part of the internal jugular vein or the left cephalosbrachial vein stenosis / occlusion) The diameter of the left transverse sinus was significantly smaller in the case group than the control group (91.1%vs.33.3%, P0.0004) MRV significantly smaller than the control group (0.31 + 0.21vs.0.41 + 0.19, P=0.0290), and Contrast T1 found no difference in the diameter of the left transverse sinus in the case group from the control group. This result was in line with the conclusion of the stenosis / occlusion of the circumfluence end of the reflux vein: the head and neck. Venous backflow disorder is one of the main causes of TGA. Bilateral internal jugular vein and / or left cephalic vein stenosis / occlusion and transverse sinus dysplasia are important factors leading to the obstruction of the head and neck venous reflux.
The second part: new evidence of head and neck venous reflux dysfunction due to transverse sinus dysplasia.
Recent studies have suggested that left lateral sinus dysplasia is mostly physiological variation, and there is no significant clinical significance. Recent studies have found that transverse sinus dysplasia is closely related to some nervous system diseases. The relationship between transverse sinus dysplasia and TGA TMB panic disorder is explored by MR and cervical venous ultrasound, and the clinical application of ultrasound in the diagnosis of transverse sinus dysplasia Value method: This study reviewed the data of three case control studies, including TGA, transient monocular blindness (TMB) and panic disorder (panic disorders). At the same time, a total of 131 cases of MR examination and cervical ultrasonography were used to measure the diameter of the transverse sinus and the location and process of the stenosis / occlusion of the jugular vein. Measurement of the area of the internal jugular vein (cross-sectional lumen area, CSA, cm2) of the internal jugular vein (cross-sectional lumen area, CSA, cm2) and blood flow rate (time-average-mean velocity, TAMV, cm/s) and blood flow in 69 cases of poorly developed transverse sinus. Anatomic transverse sinus dysplasia), 39 cases were confirmed by Contrast T1 (defined as low blood flow type transverse sinus dysplasia), the latter had at least any part of the internal jugular vein and / or the left cephalic vein stenosis / occlusion (P=0.0002) Contrast T1 showing uncompensated lateral transverse sinus tube enlargement of the neck vein Acoustic studies showed that the cross-sectional area of the lateral superior lateral segment of the lateral sinus (J3) was significantly smaller (P0.0001) in the contralateral / proximal segment of the internal jugular vein (J3) as a cut-off point for the diagnosis of transverse sinus dysplasia, with a sensitivity of 0.80, a specificity of 0.81, and a positive predictive value of 0.82: transverse sinus dysplasia could be divided into anatomic and low blood flow pattern two. The low flow of internal jugular vein and small diameter of the internal jugular vein are closely related to the obstruction of the jugular venous reflux caused by the dysplasia of the transverse sinus. The low blood flow pattern is associated with the jugular venous reflux disorder caused by the stenosis / occlusion of the jugular vein. The dissection of the jugular venous reflux caused by the anatomic type and the dysplasia of the transverse sinus is the TGA TMB panic disorder One of the main reasons
The third part: new evidence that the internal jugular vein has no reflux during VM.
The transient increased pressure of the chest and abdomen during VM is known mainly through the vertebral vein system, transmitted through the internal jugular vein, so the unobstructed internal jugular vein is the first two part of the study of the release of transient pressure and the reflux of the brain veins. MR confirms the existence of the stenosis / occlusion of the jugular vein, or congenital sinus of the transverse sinus in TGA. In this part, we use ultrasound to further study the function or hemodynamic changes of the internal jugular vein in TGA, and further verify the theory of cerebral venous reflux disorder. We assume that the hemodynamic changes of the internal jugular vein will be caused by the stenosis / occlusion of the jugular vein or congenital dysplasia. Changes, further assessment of the correlation between the head and neck stenosis / occlusion or congenital dysplasia and the obstruction of the jugular venous reflux. This study was a case-control study using the cervical vein ultrasound to observe the blood flow velocity of the internal jugular vein (including J2 and J3) in the TGA and the normal controls, and the blood flow, and VM Compared with the control group, the blood flow velocity and blood flow rate of the bilateral upper internal jugular vein (J3) and the middle segment (J2) were lower in the TGA group than in the control group, and the left side of the internal jugular vein (J3) and the middle part of the middle segment (J2). And during VM, the proportion of the internal jugular vein non reflux in the upper segment of TGA group (J3) was high, and there was no stenosis / occlusion or occlusion of the jugular vein at the right side of VM. In those with congenital dysplasia of the transverse sinus, among those with stenosis / occlusion or congenital dysplasia of the jugular vein, the proportion of the internal jugular vein without reflux is high, with the right internal jugular vein stenosis / occlusion and the transverse sinus dysplasia the conclusion: the low flow rate of the internal jugular vein and the non reflux of the internal jugular vein during VM and the stenosis / occlusion of the jugular vein or the transverse sinus during the period of the internal jugular vein Congenital dysplasia is associated with the obstruction of the jugular venous backflow, and the support of the head and neck venous backflow is one of the main causes of TGA. The non reflux of the jugular vein during VM may be used as a measure for the assessment of the obstruction of the head and neck venous reflux.
The fourth part: ultrasound diagnostic criteria for head and neck venous reflux disorders.
In order to further study the correlation between the head jugular reflux disorder and the neurological disease, the morphological changes of the MR's jugular reflux disorder were taken as the contrast, the hemodynamic changes of the jugular reflux disorder were observed by ultrasound, and the standard method of ultrasonic diagnosis for the obstruction of the jugular vein was established: a retrospective analysis of 110 cases of MR including Co Ntrast T1 TRICKS and MRV, and venous ultrasound examination included different respiratory evoked tests, such as the quiet breathing state and the VM exclusion criteria that the VM could not last 15 seconds, and the blow pressure could not reach the 40mmHg MR to evaluate the internal jugular vein (internal jugular vein, JIV) and the cephalobrachial vein stenosis / occlusion and The hemodynamic parameters of IJV and vertebral veins in different respiratory states, such as cross-sectional lumen area, CSA, cm2, and blood flow velocity (time-average-mean velocity, TAMV, cm/s) and blood flow (flow volume) were compared with or without severe stenosis / occlusion: when the upper neck was static When pulse (C1) severe stenosis / occlusion (MR result), ultrasound suggests that the CSA of the internal jugular vein (J2) of the middle segment of the ipsilateral is small, especially when inhaled, and the compression side is significantly smaller. When the middle segment of the internal jugular vein (C4) is severe stenosis / occlusion (MR result), ultrasound suggests that the calm respiration of the internal jugular vein (J3) of the ipsilateral upper segment (J3) is low, but because the variability of ultrasonic data is too large. Using the statistical method of ROC (receiver-operating characteristic, ROC), it is impossible to find out the effective ultrasound diagnosis truncation points of C1 or C4 with or without left BCV severe stenosis / occlusion: both TAMV and FV of the middle segment of the internal jugular vein (J2) are significantly lower, but the CSA appears to be higher, suggesting that the downstream of the vein is further evaluated by the ROC curve. The best truncation point in the diagnosis of BCV stenosis / occlusion was estimated. It was found that the sensitivity and specificity, sensitivity 0.78, specificity 0.61, and positive predictive value 0.63 of the TAMV value of the left middle segment of the left middle segment of the internal jugular vein (J2) were 8 (cm/s), and the positive predictive value was 0.63. A comparative study of MR and jugular vein ultrasound was used in this study to find ultrasound assessment of internal jugular static The relationship between venous reflux disorder and MR evaluation of venous morphology was related to MR, the location and degree of stenosis / occlusion of the vein was clearly diagnosed, and the blood flow velocity and diameter of the internal jugular vein in different respiratory states and the diameter of the internal jugular vein and whether the internal jugular vein returned to the neck during VM were diagnosed. Whether there is a reflux disorder in the vein, combined with MR and ultrasound, is not only clear about the presence of reflux obstruction in the jugular vein, but also the location and extent of the disease.
This study is a study of the clinical correlation between the head and neck venous reflux disorder and the nervous system disease. Through comparative study of MR and cervical venous ultrasound, we found that the carotid artery stenosis / occlusion, and the congenital dysplasia of the transverse sinus caused by the congenital dysplasia of the transverse sinus, is one of the causes of the main cause of the TGA TMB panic disorder. The low flow rate of the vein and the non reflux of the internal jugular vein during VM can be used as a measure for the assessment of the obstruction of the jugular vein. The combination of MR and ultrasound can identify the obstruction of the jugular vein and the transverse sinus.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R743.3

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本文編號：1905692